Provider Demographics
NPI:1659747756
Name:OKWELOGU, BERNARD (PHARM D)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:OKWELOGU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 E ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-2019
Mailing Address - Country:US
Mailing Address - Phone:559-470-6969
Mailing Address - Fax:559-470-6970
Practice Address - Street 1:1804 E ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-2019
Practice Address - Country:US
Practice Address - Phone:559-470-6969
Practice Address - Fax:559-470-6970
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist